peds infection 43 and immunity 42
Parents demonstrate understanding of treatment of infantile eczema when they say the following:
"I know I have to follow all the directions while using the hydrocortisone cream." Explanation: Because of the possible effects of topical hydrocortisone on the adrenal system, parents must follow directions carefully and should know not to use it unless necessary, to use it only as ordered, and not to stop using it abruptly.
What would be most important to include in the teaching plan for parents of a child with pinworm?
"Make sure the child washes his hands after using the bathroom." Explanation: The most effective measure to prevent pinworms or a recurrence is good hand hygiene, especially after using the bathroom and before eating. Sealing the child's clothing in a plastic bag is appropriate for pediculosis capitis. Having the child wear shoes at all times is helpful in preventing hookworm. Use of a cream that remains on for a specified time is associated with scabies.
Nursing students are learning about the body's response to infection. Which of the following statements made by a student indicates an understanding of the job of pus in an infection?
"Pus indicates that phagocytosis is occurring." Explanation: The action of phagocytes on organisms produces pus. Many people think the presence of pus indicates a worsening infection. More likely, it indicates phagocytosis and that the infection is resolving.
A nursing instructor teaching about allergies in children informs students that the underlying cause of all allergic disorders appears to be an excessive antigen-antibody response when the invading organism is which of the following?
Allergen Explanation: The underlying cause of all allergic disorders appears to be an excessive antigen-antibody response when the invading organism is an allergen and not a simple immunogen.
A nurse is assisting with skin testing for allergies in a 14-year-old girl. What should the nurse do to ensure an accurate test?
Be certain that the child has not received an antihistamine in the past 8 hours. Explanation: Skin testing is done to detect the presence of IgE in the skin, or to isolate an antigen (allergen) to which the IgE is responding or to which a child is sensitive. When an allergen is introduced into the child's skin and the child is sensitive to that allergen, a wheal or flare response will appear at the site of the test from the release of histamine, which leads to local vasodilation. Because this reaction appears quickly, the test should be read in 20 minutes, not 40 minutes. Systemic or aerosol administration of an antihistamine will inhibit the flare response, so be certain the child has not received these drugs for 8 hours before skin testing. Because intracutaneous injections are given just below the epidermal layer of skin (not in the muscle), they are almost painless; thus, no anesthetic is needed.
The nurse is performing a physical examination for a 7-year-old girl who was bitten by a tick. What would alert the nurse to the possibility of early localized Lyme disease?
Bull's-eye rash around the bite Explanation: A bull's-eye rash (ring-like rash) around the bite is typical of early localized Lyme disease. Multiple erythema migrans on the skin occurs during early disseminated disease. Cranial nerve palsies are indicative of early disseminated disease. Recurrent arthritis in the large joints occurs in the late stage of the disease.
A 6-year-old child is brought to the clinic by his parents. The parents state, "He had a sore throat for a couple of days and now his temperature is over 102° F (38.9° C). He has this rash on his face and chest that looks like sunburn but feels really rough." What would the nurse suspect?
Correct response: Scarlet fever Explanation: Scarlet fever typically is associated with a sore throat, fever greater than 101° F (38.9° C), and the characteristic rash on the face, trunk, and extremities that looks like sunburn but feels like sandpaper. CAMRSA is typically manifested by skin and tissue infections. Diphtheria is characterized by a sore throat and difficulty swallowing but fever is usually below 102°F . Airway obstruction is apparent. Pertussis is characterized by cough and cold symptoms that progress to paroxysmal coughing spells along with copious secretions.
The school nurse is walking through the lunchroom when one of the children says she started to feel strange after trading lunches with a friend. Which assessment would be most important?
Determining if her throat itches Explanation: Asking if the child's throat itches is most important because this aids in determining airway patency, which is always the priority. Asking about a rash, nausea, or abdominal pain can be done after the nurse is certain the child's airway is not jeopardized.
A child with primary immune deficiency is about to receive an infusion of IVIG. What is the most appropriate premedication to minimize the reaction?
Diphenhydramine Explanation: Diphenhydramine and acetaminophen are the most commonly used medications for this purpose. Nonsteroidals and steroids typically are not used for this indication.
A nurse is teaching a child with allergies and his parents about his prescribed therapy with diphenhydramine. The nurse determines that the teaching was successful when the child and parents identify which of the following as a possible adverse effect? Select all that apply.
Drowsiness Dizziness Dry mouth Explanation: Possible adverse effects of diphenhydramine include drowsiness, dizziness, dry mouth, sedation, epigastric distress, hypotension, and thickening of bronchial secretion. Diphenhydramine is not associated with muscle pain or bleeding.
A nurse is giving a talk to high school students about preventing the spread of human immunodeficiency virus (HIV). What does the nurse identify as ways in which HIV is spread? Select all that apply.
Exposure to blood and body fluids through sexual contact Sharing contaminated needles Transfusion of contaminated blood Perinatally from mother to fetus Through breastfeeding Explanation: HIV is spread by exposure to blood and other body fluids through sexual contact, sharing of contaminated needles for injection, transfusion of contaminated blood, perinatally from mother to fetus, and through breastfeeding.
A nursing student learning about childhood infectious diseases correctly identifies which of the following as the disease related to chickenpox, which tends to occur in older children or young adults?
Herpes zoster Explanation: Herpes zoster is caused by varicella-zoster virus, the same virus that causes chickenpox.
When describing anaphylaxis to a group of parents whose children have experienced anaphylaxis from insect stings, the nurse integrates knowledge that this response is related to which immunoglobulin?
IgE Explanation: Anaphylaxis is an acute IgE-mediated response to an allergen that involves many organ systems and may be life-threatening.
The nurse is caring for a child who is receiving a skin test to determine the presence of allergies. A positive skin test for one particular allergen shows the mediation of which type of immune globulin?
IgE Explanation: Skin testing is done to detect the presence of IgE in the skin that responds to a particular allergen. IgM is part of the body's primary response, and IgG is part of the body's secondary response to infection. IgA is present in the mucous membranes of the body to fight against infection.
When teaching a group of new parents about newborn care and development, which immunoglobulin would the nurse explain as being primarily responsible for the passive immunity exhibited by newborns?
IgG Explanation: IgG is acquired transplacentally, providing the newborn with passive immunity to antigens to which the mother had developed antibodies. IgA, IgD, IgE, and IgM do not cross the placenta and require an antigenic challenge for production.
Nursing students are learning about the infectious process. They correctly identify the first stage of an infectious disease to be the:
Incubation period Explanation: The incubation period is the first stage of the infectious disease. It is the time between the invasion of an organism and the onset of symptoms of infection.
A nurse is preparing a plan of care for a child with a primary immunodeficiency. Which nursing diagnosis is the priority?
Ineffective protection related to impaired humoral defenses Explanation: The child with a primary immunodeficiency lacks the necessary immune responses that provide protection from infection. Therefore, the priority nursing diagnosis would be ineffective protection. Imbalanced nutrition and risk for delayed growth and development may be appropriate, but these would not be the priority. Acute pain would be more appropriate for a child with juvenile idiopathic arthritis.
A child in the clinic has a fever and reports a sore neck. Upon assessment the nurse finds a swollen parotid gland. The nurse suspects which infectious disease?
Mumps Explanation: Mumps is an infectious disease with a primary symptom of a swollen parotid gland.
The nurse is discussing medications to be given to a child who has been diagnosed with Candidiasis. Which of the following medications would most likely be prescribed for the child?
Nystatin Explanation: Application of nystatin (mycostatin, nilstat) to the oral lesions every 6 hours is an effective treatment for candidiasis. Treatment for diaper rash caused by candida albicans is the application of nystatin ointment or cream to the affected area.
A nursing instructor teaches students about the possibility of pregnant women with HIV infecting their fetuses. Which of the following statements by a student indicates the need for further teaching about pregnancy and HIV?
Pregnancy will definitely accelerate the progression of the disease. Explanation: Of the nearly 1,000,000 people in the United States infected with HIV, 25% are female. The infection has become the leading cause of death in women 25 to 44 years. Of every 1,000 women giving birth, 1% to 2% are HIV positive. When the disorder is discovered during pregnancy, pregnancy does not appear to accelerate the progression of the diseas
A nursing instructor teaches students about the possibility of pregnant women with HIV infecting their fetuses. Which of the following statements by a student indicates the need for further teaching about pregnancy and HIV?
Pregnancy will definitely accelerate the progression of the disease. Explanation: Of the nearly 1,000,000 people in the United States infected with HIV, 25% are female. The infection has become the leading cause of death in women 25 to 44 years. Of every 1,000 women giving birth, 1% to 2% are HIV positive. When the disorder is discovered during pregnancy, pregnancy does not appear to accelerate the progression of the disease.
Which nursing problems could be associated with a child with primary immunodeficiency? Select all that apply.
Risk for infection Altered skin integrity Delayed growth and development Explanation: All of these can be problems associated with immune system dysfunction. Fluid and electrolytes and GI function are not commonly associated with primary immunodeficiency.
The nurse is instructing a group of women of childbearing age about human immunodeficiency virus (HIV) during pregnancy. What would be a priority recommendation in this setting?
Screening for HIV Explanation: No screening mandate has been put forth for HIV, but all pregnant women should be encouraged to undergo this test. Prophylactic treatment would be initiated only once the woman has been screened. Screening for STIs and ensuring proper nutrition are also part of health promotion for women in this age group, but they are of lower priority than identifying HIV-positive individuals.
A school-aged child with an infectious disease is placed on transmission-based precautions. Which nursing diagnosis would be the priority?
Social isolation related to infectivity and inability to go to the playroom Explanation: Children who are placed on transmission-based precautions are not allowed to leave their rooms and are not allowed to go to common areas such as the playroom or schoolroom. Thus, they are at risk for social isolation. Impaired skin integrity, fluid volume deficit, and deficient knowledge may be appropriate but would depend on the infectious disease diagnosed.
The nurse is performing a physical examination of an 8-year-old girl who was bitten by her kitten. Which assessment would lead the nurse to suspect cat-scratch disease?
Swollen lymph nodes Explanation: Lymph nodes, especially under the arms, can become painful and swollen due to cat-scratch disease. Strawberry tongue is typical of scarlet fever. Infected tonsils and an edematous neck are symptoms of diphtheria.
Which immune cells are disrupted when a child is infected with human immunodeficiency virus (HIV)? Select all that apply.
T cells B cells Phagocytes
One method of preventing communicable diseases in children is to administer vaccines to stimulate the development of antibodies. Which of the following best describes what occurs in the child when vaccines are given?
The child develops an active immunity. Explanation: When a vaccine is given, active immunity occurs which then stimulates the development of antibodies to destroy infective agents without causing the disease.
A young girl arrives at the emergency room after being bitten by a neighbor's dog. The mother is concerned her daughter will get rabies. The nurse carefully examines and treats the bite and questions the mother and daughter about the details surrounding the dog biting her. What information would most strongly indicate a risk for rabies infection in this client?
The dog was unprovoked when he bit the girl Explanation: An unprovoked attack is much more suggestive that the animal is rabid, rather than if the bite happens during a provoked attack. The dog being immunized for rabies and there being no other reported instances of rabies in the area would indicate a lower risk that the dog was rabid. The fact that the dog belonged to a neighbor does not necessarily indicate a lower risk for rabies infection.
Which of the following is the drug of choice for multidrug-resistant strains of infection?
Vancomycin is the drug of choice for serious infections involving multiple drug-resistant strains. Sensitive strains respond to most antibiotics including erythromycin and clindamycin. Most community-acquired MRSA infections can be treated on an outpatient basis with trimethoprim-sulfoxazole or clindamycin.
An older school-aged child is allergic to wasp stings. The nurse is teaching the child and her parents about ways to minimize her risk. Which of the following would the nurse include in the teaching plan? Select all that apply.
Wearing appropriate footwear when going outside Having a readily available fast-acting insecticide when outdoors Not drinking from open soda cans when outside Explanation: Teach children who are allergic to stinging insects and their parents not to use scented preparations such as hair spray, deodorants, lotions, or perfume because these attract bees and wasps. They should not go outside barefoot because bees are often found in ground clover. They should not be assigned household chores such as mowing the lawn or weeding the garden, actions that might stir up bees. Because insects tend to cluster around garbage containers, taking out the trash is also an inappropriate chore for these children. Caution a child to have a fast-acting insecticide handy when out of doors to use on flying insects. Encourage a child to refrain from drinking from open soda cans at picnics and outside activities; bees and wasps are drawn to the sugar in the soda, and the child may be unaware that an insect has entered the open can.
The nurse is caring for a newborn whose mother is HIV positive. The nurse would expect to administer a 6-week course of which medication?
Zidovudine Explanation: Children born to HIV-positive mothers should receive a 6-week course of zidovudine therapy. Lopinavir, ritonavir, and nevirapine are medications used for treatment of HIV-1 infections as part of a three-drug regimen.
A young client arrives at the clinic with a rash on the trunk and flexor surfaces of the extremities. The mother informs the nurse that the rash started a day before on the exterior surfaces of the extremities; 2 days before, the child had a really bad rash on the face. The physician diagnoses the child with erythema infectiosum. The nurse tells the mother that this is also known as:
fifth disease. Explanation: Erythema infectiosum is also known as "fifth disease." It starts with a fever, headache, and malaise. One week later, a rash appears on the face. A day later, the rash appears on the extensor surfaces of the extremities. One more day later, the rash appears on the trunk and flexor surfaces of the extremities.
A child is diagnosed with group A streptococcal pharyngitis. The nurse would teach the parents to be alert for signs and symptoms of:
scarlet fever. Explanation: Group A streptococcal pharyngitis can progress to scarlet fever with the rash appearing in about 12 hours after the onset of the disease. Group A streptococcal pharyngitis is not associated with pneumonia. Impetigo is a group A strep infection involving the skin. Osteomyelitis can occur with an infection by group B streptococcus.
Nursing students demonstrate an understanding of how the body protects itself from invasion of bacteria when they identify which of the following as physical protective barriers?
skin cilia mucous membranes Explanation: The immune system uses several mechanisms to protect the body from invasion by foreign substances. The body surfaces such as the skin, cilia, and mucous membranes act as physical barriers.
A nurse is preparing a presentation for a group of new parents and is planning to discuss nutrition during the first year. As part of the presentation, the nurse is planning to address foods that should be avoided to reduce the risk of possible food allergies. Which foods would the nurse most likely include? Select all that apply.
Eggs Shrimp Peanuts Explanation: Foods that should be avoided in children younger than 1 year of age include cow's milk, eggs, peanuts, tree nuts, sesame seeds, and fish and shellfish (i.e., shrimp). Carrots, potatoes, and bananas are not considered problematic.
When teaching about primary and secondary humoral responses, what should the nurse identify as the immunoglobin that is first to appear in the serum?
IgM Explanation: IgM is the first immunoglobin to appear in the serum with the primary and secondary humoral responses.
A nurse is instructing the parents of a child who is suspected of having pinworms how to check the child. Which of the following instructions would be most appropriate?
Inspect the child's anus with a flashlight 2 to 3 hours after he is asleep. Explanation: Diagnosis is confirmed by direct visualization of worms by the parents or by microscopy. Tell parents to view the child's anus with a flashlight 2 to 3 hours after the child is asleep. The worm is white, thin, and about 1/2 inch long, and it moves. Pinworms are not identified as black dots on bed linens. Specimens are best obtained as the child awakens before toileting or bathing. Checking the washcloth would be of no benefit. Pinworms do not change the appearance of the stool.
The nurse is caring for a child undergoing highly active antiretroviral therapy (HAART) for HIV infection. The nurse is preparing to administer the prescribed medication. In addition to the nucleoside analog reverse transcriptase inhibitors (NRTIs) and the nonnucleoside analog reverse transcriptase inhibitors (NNRTIs), the nurse is cognizant that the child will be taking which additional medication as part of the three-drug regimen?
Protease inhibitors Explanation: The nurse understands that the child will be taking protease inhibitors as part of the three-drug regimen for HAART. Corticosteroids, cytotoxic agents, and DMARDs are typically used for the treatment of juvenile idiopathic arthritis (JIA).
A nurse practitioner suspects that a child has scarlet fever based on which assessment finding?
Red, strawberry tongue Explanation: The characteristic assessment finding that distinguishes scarlet fever from other disorders is the appearance of the red, strawberry tongue. Sore throat, an enanthematous and exanthematous rash, and white exudate on the tonsils are also seen with scarlet fever, but it is the strawberry tongue that helps to confirm the diagnosis.
What information should be included in the teaching plan for a child with varicella?
Remind the child not to scratch the lesions. Explanation: The teaching plan for varicella should include that the child not scratch the lesions. Acetaminophen should be administered for fever, not aspirin, due to the link with Reye syndrome. The best treatment for skin discomfort is a cool bath with soothing colloidal oatmeal every 3 to 4 hours for the first few days. The child should avoid citrus, spicy, or salty foods.
A young child who has been reporting fatigue and running a low-grade fever for 4 days begins to have pustules over the entire body. The physician diagnoses chickenpox. The period before the pustules developed is referred to as the:
prodromal period Explanation: The prodromal period is between the beginning of nonspecific symptoms and disease-specific ones.
A woman in her fourth month of pregnancy has recently learned that her sexual partner is HIV positive. She agrees to be tested for the virus but asks the nurse what early symptoms she should be looking for in herself. Which of the following should the nurse mention to the client?
Mild, flu-like symptoms Explanation: Unlike other sexually transmitted infections, HIV infection rarely begins with reproductive tract lesions. Instead, early symptoms are more subtle and often difficult to differentiate from those of other diseases or even from the symptoms of early pregnancy such as fatigue, anemia, diarrhea, and weight loss. The initial invasion of the virus may be accompanied by mild, flulike symptoms.
The nurse is performing a physical examination on a 9-year-old boy who has experienced a tick bite on his lower leg and is suspected of having Lyme disease. Which assessment finding would the nurse expect to find?
Ring-like rash on lower leg Explanation: A ring-like rash at the site of the tick bite is characteristic for Lyme disease. Swelling in the neck is a symptom of mumps. Confusion, anxiety, and hypersalivation are symptoms of rabies.
The nurse is caring for a child with clear nasal drainage, pale nasal mucous membranes, and a horizontal crease on the nose. What does the nurse suspect?
Allergic rhinitis Explanation: Clear nasal drainage, pale mucous membranes, and a horizontal crease on the nose are all symptoms of allergic rhinitis. Atopic dermatitis has dry, itchy patches of skin, whereas upper respiratory infections often involve a cough and a sore throat, and sinusitis usually is marked with a cough and facial pressure or headaches.
A high school football player comes to the clinic with malaise, fever, headache, and anorexia that have been present for the last few days. Upon physical examination, the nurse notes that the cervical lymph nodes are firm and tender. Tonsils are red and enlarged and appear to have a white covering. What should the nurse suspect the diagnosis to be for this patient?
Mononucleosis Explanation: Infectious mononucleosis occurs most commonly in adolescents and young adults. Beginning symptoms include chills, fever, headache, anorexia, and malaise. Children develop enlarged lymph nodes and a severe sore throat. The cervical lymph nodes feel tender and firm. The tonsils feel painful and are enlarged and erythematous. A thick, white membrane may cover the tonsils; often, petechiae appear on the palate. The spleen may enlarge, which places the child at risk for spontaneous rupture.